Differential Diagnosis of Elevated IgE

Atopic disease
- Level usually highest in AD > asthma > perennial AR > seasonal AR
- It is theorized that non-atopic patients with elevated IgE and chronic rhinosinusitis (or asthma or AD) may have high level of sIgE to staph antigens
ABPA
CF
Churg-Strauss
Cutaneous disease
- AD
- Netherton syndrome
- Bullous pemphigoid
Infection
- Non-parasitic
  - EBV
  - CMV
  - HIV
  - TB
  - Leprosy
- Parasitic infections including the following:
  - Cestodes (Echinococcus)
  - Trematodes (Schistosoma)
  - Nematodes (Ascaris, Toxocara)
  - Strongyloides
  - Ancylostoma
  - Capillaria
Malignancy
- IgE myeloma, IgE monoclonal gammopathy
- Hodgkin lymphoma
Immunodeficiency
- Hyper-IgE syndrome
- Omenn syndrome
- Wiskott-Aldrich
- IPEX
- Atypical complete DiGeorge syndrome
- Nezelof syndrome (thymic dysplasia with normal immunoglobulins)
Kawasaki disease
Nephrotic syndrome
Post bone marrow transplantation
Cigarette smoker
Alcoholism
Polyarteritis nodosa

IgE Deficiency

Selective IgE deficiency is defined as serum IgE <2 IU/L in a patient whose other immunoglobulin levels are normal
- Undetectable serum total IgE may serve as a marker of immune dysregulation and autoimmunity
- Selective IgE deficiency is associated with significantly higher prevalence of asthma, chronic sinusitis, otitis media, autoimmune, and oncological diseases in children and adults (vs. normal controls)